A follow up from my last blog post on a home visit that touched me as well as the family I went to see. After I left the home the frail man with end stage COPD he was in good spirits and at peace. Toward the evening he began to hurt a little in his side and abdomen and began to feel anxious as his breathlessness always worsened in the evenings. He took about half the dose of medication I recommended, but his wife said that was enough to settle him down and make him comfortable.
The next morning he kept on sleeping in his recliner chair from the night before and wouldn't wake up. His wife now anxious as to what to do and unable to arouse or move her husband (to do what I'm not sure) called the office to ask for advice. My nurse having just returned from vacation and not wanting to pull me out of a room with another patient recommended she call 9-1-1. Fortunately she told me before the wife had a chance to do this, so I canceled the order and headed back up to their house since it was lunchtime anyway.
Upon my arrival the wife and patient's son greeted me and we sat in the living room where I had been the day before and just watched him breathe. He looked so comfortable in his recliner chair--no pain, no air hunger, no gurgled secretions. I tried to arouse him too and listened to his heart and lungs. I had brought along some Narcan on the chance this seemed to be opioid related, but the dose and timing was all wrong. This wasn't overmedication. This was a readiness to die.
As we talked about where to go from here we were all fine with leaving him in his recliner. He wouldn't have wanted the ER and ambulance and there really was no purpose for it. I described for them what happens when someone enters a terminal type syndrome like this. I told them to tell the rest of the family if they wanted to see him one last time now was the time. A few came over that night and paid their last respects. By the next morning he had quietly and peacefully passed away.
I am thoroughly convinced some know when their end is near. He just needed to make sure his family was ready and that he wouldn't suffer at the end. I honestly think the home visit the day before gave this to him. When he went to sleep that night it was as if he was able to relax and let go. He was ready to die. We should all be so lucky to have a death as good as his.